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JUST HOW MESSY WOULD REPEAL GET? — If Mitt Romney wins next week, he’ll have several options to weaken and partially dismantle the Affordable Care Act. And he might need to use them all since it’s looking like Democrats have a decent shot at keeping control of the Senate, making it virtually impossible for Romney to repeal “Obamacare” in one clean shot. Romney and his HHS secretary could slow-walk implementation, rewrite rules, shut off some funding and take pieces of the law apart. “If you’re in charge of the executive branch, there’s a lot you can do,” said Timothy Jost, a Washington and Lee University law professor who supports the ACA. The process of unwinding the law could create a total mess for health care stakeholders, and it could also spark a new wave of litigation from those who want to see the law implemented.

--On the regulatory front, the process for undoing federal rules is complex, and it could cause widespread uncertainty across the health sector. “You don’t want a zombie law where they cut off the head and the provisions keep marching down the track toward implementation,” said the National Retail Federation’s Neil Trautwein. Sounds like a perfect horror movie right in time for Halloween. Someone should get on that. The POLITICO Pro story: http://politico.pro/P9oOlT

Good Monday morning and welcome to PULSE, where we’re hunkering down for a couple of days of crazy weather. PULSE’s storm preparations this weekend included the acquisition of two big bags of Halloween candy, so yeah, we feel pretty ready.

“And I wonder, still I wonder who’ll stop the PULSE.”

TODAY ON POLITICO PRO:

--FDA FINDS NASTY THINGS AT NECC – “Greenish black foreign matter” and “white filamentous material.” That’s what FDA inspectors found in about 100 vials in a bin of steroid injections at the New England Compounding Center linked to the meningitis outbreak that’s claimed at least 25 lives so far. http://politico.pro/UWkl8A

--EXCHANGE WEEK: PICKING A NAME – Two more states play the exchange name game, while another looks to 2015 to get fully off the ground. http://politico.pro/SrW4EO

--STATE BATTLES PERSIST FOR PLANNED PARENTHOOD – Since last year, nine states have tried to defund Planned Parenthood. The group has fought back against six states in court, and it’s been successful in five so far. http://politico.pro/QOy5OJ

TREASURY IGNORES SUBPOENA THREAT — The House Oversight and Government Reform Committee had threatened a subpoena unless the Treasury Department handed over internal documents related to an IRS rule providing subsidies in federal health insurance exchanges. But the Treasury Department, citing executive branch “confidentiality interests,” says it can’t peel back the curtain on how it decided federal-run exchanges can provide subsidies in the same fashion as state-based exchanges. “It is well-established that agency staff and counsel must have the ability to engage in free, full, and unfettered discussions and debate about important policy and legal matters,” Treasury wrote. “Accordingly, as the Executive Branch has long maintained, public disclosure of such material could have a significant chilling effect on agency staff and could inhibit their ability to fulfill their statutory responsibilities.” Oversight Committee Chairman Darrell Issa (R-Calif.) didn’t indicate what his next move might be, but he called the administration’s refusal to turn over the documents “stunning.” The POLITICO story: http://politi.co/WTcYPZ

--The Treasury letter also pointed out that the IRS rule is being challenged in federal court by Oklahoma’s attorney general, and the department said any questions about the rule should be settled by the courts. “We strongly disagree with these claims, and we intend to defend the lawsuit vigorously.” The Treasury letter: http://1.usa.gov/RkMymZ

MASSACHUSETTS SHUTS DOWN PHARMACY – Massachusetts officials closed down a specialty pharmacy similar to NECC after finding “significant issues” where sterile, injectable medications were made. The state sent a cease-and-desist order on Oct. 23 to Infusion Resource in Waltham, and the pharmacy voluntarily surrendered its license this weekend, the Boston Globe reported yesterday. Still, a state health official described the actions as “precautionary” and said there wasn’t any evidence yet of contaminated products coming from the facility. More from the Globe: http://bo.st/WToFpY

** A message from the Natural Products Association: Take your vitamins: Dietary supplementation saves billions of dollars in health care costs. For more facts on vitamins and other dietary supplements, visit www.NPAInfo.org. **

IDAHO PANEL RECOMMENDS STATE-RUN EXCHANGE — The special exchange study group set up by Republican Gov. Butch Otter gave a big endorsement to a state-based health exchange on Friday afternoon, reports the Spokesman-Review. The study group — set up in the aftermath of the Supreme Court ruling — called on the state to establish a private nonprofit to run the exchange. Just two of the group’s 13 members voted against the plan. The recommendations now go to Otter, who in the past has been pretty vocal about his preference for an Idaho-run exchange despite his opposition to the ACA. More from the Spokesman-Review: http://bit.ly/RUAhnr

INSURERS WORRIED ABOUT ROMNEY – Though they’ve spent millions upon millions to defeat the Affordable Care Act, health insurers are worried about what a Romney presidency would mean for business, The Associated Press writes. Despite their opposition to the law, insurers stand to gain billions in new revenue when the major coverage expansions take effect. And things could get particularly hairy if Romney successfully knocks out the ACA’s subsidies and the individual mandate while keeping the pre-existing condition coverage requirements. But don’t expect the industry to get behind total repeal, former Cigna executive Bill Hoagland told the AP. “They will probably try to find the particular provisions that cause them heartburn but not throw the baby out with the bath water,” he said. The AP story: http://bit.ly/S3kWkh

RNC CHAIR: MOURDOCK NOT A CONCERN – Reince Priebus played down the impact of Indiana Republican Richard Mourdock’s comments on rape and pregnancy during an interview on CNN yesterday. When asked about the Obama campaign’s efforts to tie Romney to Mourdock’s and Rep. Todd Akin’s comments, the RNC chairman said voters care much more about the economy and Libya. “I don’t think any party has a monopoly on gaffes. Clearly people running for office misspeak and they make mistakes,” Priebus said. “The reality is overwhelmingly the people out there are not talking about what Richard Mourdock said. They are talking about the economy and what happened in Benghazi.”

--SEN. RON JOHNSON: ABORTION NOT AN ISSUE – The Wisconsin Republican was also asked yesterday about how abortion is affecting the election cycle. His answer: It’s not. “It’s not even an issue here in Wisconsin,” Johnson said when asked about some of the more controversial statements this cycle. “It doesn't even move the radar at all.” http://politi.co/VwLlY0

--GINGRICH: GET OVER IT – The former House Speaker, appearing on ABC’s “This Week,” downplayed the comments. “One point of this is nonsense,” he said. “Every candidate I know, every decent American I know, condemns rape. OK, so why can’t people like Stephanie Cutter get over it?”

BUSH BACKS THOMPSON – Former President George H.W. Bush, who typically avoids endorsements, officially announced his support of Wisconsin Republican Tommy Thompson in the state’s Senate race. Bush noted in a campaign email that his own son asked Thompson to serve as his health secretary. “[T]hankfully, Tommy answered his country's call,” Bush wrote.

WHAT WE’RE READING

A report from Rep. Ed Markey (D-Mass.) finds that the FDA doesn’t have enough power to regulate compounded drugs like the ones linked to the meningitis outbreak, according to Reuters. http://reut.rs/WUcHwm

The Obama administration will soon sponsor at least two nationwide health insurance plans, but plenty of questions remain about how they will interact with state laws and rules, The New York Times writes. http://nyti.ms/XAk9vd

The L.A. Times takes a look at the crucial role that nonprofit community clinics will play when the ACA’s coverage expansion takes effect. http://lat.ms/RYllEI

Health care providers in the path of Hurricane Sandy have canceled elective surgeries and sent patients home to free up beds, Modern Healthcare reports. http://bit.ly/YbASEs

More and more employers over the next 18 months will shift their employees into health plans with higher deductibles, Reuters reports. http://reut.rs/U7BXcm

Zeke Emanuel, writing in The New York Times, offers four “myths” about doctor-assisted suicide as Massachusetts voters will soon decide on the issue in a ballot measure. http://nyti.ms/S3ZOtH

** A message from the Natural Products Association: The Natural Products Association, founded in 1936, is the largest and oldest nonprofit organization dedicated to the natural products industry. NPA represents over 1,900 members accounting for more than 10,000 locations of retailers, manufacturers, wholesalers and distributors of natural products, including foods, dietary supplements and health/beauty aids. As the leading voice of the natural products industry, the NPA’s mission is to advocate for the rights of consumers to have access to products that will maintain and improve their health, and for the rights of retailers and suppliers to sell these products. For more information, please visit www.NPAInfo.org. **